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SITE ADDRESS � � <br />LEGAL LOTNO. <br />DESC. <br />F� :RMIT APPLICATI� ,V <br />ClTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />S� Cv <br />BLOCK <br />PARCEL TAX I.D. # <br />� M� �c w�+ <br />TRACT OR SUB IVISION # <br />.. a3 �1v <br />_ -----� <br />X%OD� - <br />o � �- o <br />S�v�r/ /��� P«�� � ��.-� E �; <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />1���./ c i-� �,J 20 6 3 s�3 g � a- <br />E-MAIL <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />CONTR. LICENSE# W� ST C P I , O a-� IP(� � Z��, �{Jt ��� �� <br />IN 9�0� � n/ 1/1 L�L (.✓ii"�1 (� 7� <br />USE OF BUILDING I HEAT SOURCE � CONTRACT PRICE OF WORK <br />�CS7�Ic/2 /kr� 7 <br />WORK DESCRIPTION <br />A� � J <br />_ Eleciric _ Gas _ Other <br />� ���►� <br />�-NJ <br />N0. I TYPE OF FIXTURE OR ITEIVI <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink &,�isposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Olher� ��� s/r1�1%� <br />S i �I< �2 I�U��E � 7. <br />� w o I-� A-n�1j S r i.l /< <br />MECHANICAL <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit hea�er <br />Rm�r G(L � L L <br />Reirigeration <br />Woodslove <br />other 13 %LO /L ��, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify lhat I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br />ordinances governing lhis type of work will be complied with whelher specifed herein or not. The granting of a permit does not presume <br />lo give aulhorily to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />consiruction. That I am au�horized by the owner of this property lo perform Ihe work forwhich application is made and I comply with the <br />State Contractors Law 18.27 R W and 29fi�200 WAC. <br />i�� �'z�- r� <br />��2 <br />�� <br />